Surgical menopause

Surgical menopause is sometimes a necessary procedure to reduce the risk of various cancers, but it is associated with some short- and long-term health repercussions. Rahman and Okunoye discuss strategies for deciding the clinical management of patients.

Abstract

The word ‘menopause’ derives from the Greek words men (month) and pausis (cessation) and literally means the last menstrual period, also indicating the end of the fertile phase of a woman’s life. The average age for natural menopause is 51 years, the typical age range is 41 to 60 years, and varies depending on ethnicity, family history, co-morbidity and lifestyle.¹ In natural menopause, the transition from reproductive years (peri-menopause or climacteric phase) is usually gradual and can take several months to up to a few years. The peri-menopause state is associated with gradual onset of physical symptoms secondary to an overall drop and fluctuations in levels of oestrogen and progesterone, the most common being hot flushes and night sweats.

In the medium term, clinical manifestations include vaginal dryness, reduced libido, urogenital atrophy and psychological effects. Long term consequences include increase in cardiovascular disease, dementia, osteoporosis, sexual dysfunction and body fat redistribution to the abdomen.

In contrast, surgical menopause (bilateral oophorectomy prior to physiological menopause) results in an abrupt reduction in hormone levels with sudden onset of withdrawal symptoms and is associated with increased risk of long term morbidity and mortality.² Decision for oophorectomy should therefore be made after careful consideration of the individual woman’s demographic, clinical and genetic factors, following thorough counselling of risks and benefits…

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Jacques Clarkson
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